The Big Ugly Bill just got uglier for Iowa

This isn't about waste and fraud

Photo by Louis Velazquez on Unsplash

Chuck Grassley and Joni Ernst just made it harder for Mariannette Miller-Meeks to deceive Iowans about the pending cuts to Medicaid.

I’ve written before how the congresswoman from Iowa’s First District isn’t being honest about the Medicaid cuts in President Trump’s Big Ugly Bill that passed the House in May. But now, the Senate’s version, which narrowly passed that chamber Tuesday by a 51-50 vote, proposes far deeper cuts.

Miller-Meeks knows this. After the House’s approval of Trump’s tax and spending bill, she and Zach Nunn joined a letter objecting to the Senate’s deeper Medicaid cuts.

The Senate ignored their plea.

Grassley and Ernst joined all but three Republicans to vote for the bill Tuesday. All the Democrats opposed it.

Now, far more people will lose insurance coverage because of this bill.

The non-partisan Congressional Budget Office puts the figure at nearly 12 million by 2034.

So, what will Miller-Meeks and Nunn do now that the bill goes back to the House?

I fully expect they will ignore the letter they signed a week ago and vote with Trump.

The reason is simple: They want to stay in Congress. Trump has already made clear dissenters will draw his wrath.

Not so simple is how politicians in Des Moines will deal with the Medicaid cuts that, along with other health care programs, add up to almost $1 trillion nationwide over 10 years.

To achieve these reductions, the Senate measure dramatically restricts funding mechanisms that states like Iowa have used for years to fund their Medicaid programs.

One of them is the provider tax. Iowa is a heavy user of the provider tax, which makes an assessment on hospitals or other service providers that are participating in the Medicaid program.

Critics call these taxes a gimmick because the proceeds just get funneled back into additional Medicaid spending, costing the federal government more money. But the American Hospital Association says they’re a legal and heavily regulated way to fund a program that doesn’t come close to covering their costs because of low reimbursement rates. Without these taxes, critics say, Medicaid services will be reduced, and providers will be forced to cut staffing or programs—or even close their doors.

I have some sympathy for both sides of the argument. But regardless of whether you think these taxes are a gimmick or not, reducing them will undoubtedly have a significant impact on Medicaid programs.

In other words, we’re no longer just talking about cutting Medicaid for people who don’t work.

How bad will it be?

In Louisiana, health systems said the Senate cuts would be “historic in their devastation,” according to Politico.

I don’t know what will happen in Iowa, but the Kaiser Family Foundation said Iowa is among the 22 states that could be forced to lower its tax on providers.

What then?

Congressional Republicans claim their cuts won’t hurt the disabled, the aged or kids. But that’s not what people who advocate for them say.

Consider the following paragraph from an article last week in Disability Scoop, a publication that covers policies affecting people with developmental disabilities. The article quotes Elena Hung, who is co-founder and executive director of Little Lobbyists, a national group that advocates for children with disabilities.

“History shows that when Medicaid budgets are cut, home and community-based services are among the first services cut,” said Hung, whose group brought families from across the country to Capitol Hill last week to pressure senators to reject Medicaid cuts. “Millions of Americans, including disabled and medically complex children, are in imminent danger of losing Medicaid. The threat is dire.”

Home and Community-Based Services, or HCBS, provide services such as basic living assistance so people can stay in their homes, instead of living in institutions, as well as employment help so the disabled can join the workforce.

These services make a huge difference in the lives of millions of Americans. But advocates say they are at risk. In 2010-12, when Medicaid funding got cut after the Great Recession, all 50 states reduced their HCBS programs, according to a letter sent to the Senate this month and signed by members of hundreds of advocacy groups, including a dozen from Iowa.

Lately, Miller-Meeks has been on social media emphasizing the benefit of extending the tax cuts, rather than the effects of Republican policies on Medicaid. And, yes, if those cuts aren’t extended, it would mean a tax increase for millions of Americans. But congressional Republicans could have prevented this by extending the tax cuts for most Americans, reduced some of the benefits that are going to billionaires and resisted the temptation to load up this mammoth 1,000-page bill with a bunch of goodies that are being partially paid for by yanking health insurance away from nearly 12 million Americans.

US Rep. Mariannette Miller-Meeks, R-Iowa (Official photo)

Take the federal deduction for state and local taxes. Formerly capped at $10,000, it now will grow to $40,000.

Hardly anybody in Iowa will benefit from this. But wealthy people in Democrat-run, high-tax states like California and New York are overjoyed today because they’re on the way to getting a fat new tax break. According to a USA Today article, it’s not clear why the Senate bill was so accommodating, but one critic said it had all the hallmarks of “backroom dealmaking to win votes.”

Iowa Republicans used to lampoon Democrats for trying to pass this same tax break when Joe Biden was president. But then Trump, in an attempt to help Republican congressional candidates, reversed course last year and said he was for it, too.

So, it is now part of the Big Ugly Bill, and Iowa’s congressional delegation is falling in line to vote for it.

The Committee for a Responsible Federal Budget says if this regressive and expensive tax break were reduced, it would save the federal government hundreds of billions of dollars.

Why would any representative from Iowa vote for a tax break that mostly benefits rich people in blue states, while making drastic cuts to Medicaid that will hurt the poor and disabled in Iowa?

I suspect they’ll continue to say these cuts are only to waste and fraud. But that’s not the truth.

The truth is, millions of Americans won’t be able to avoid being harmed by the nearly $1 trillion in cuts to health care over the next decade.

If there’s any justice, the politicians who voted for this won’t be spared the pain, either.

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